[alkonaut]

> he only way I can see that working out is if he feels that none of the influenza seasons in the past 50 years count as "severe".

Or that he doesn't think deaths in past influenza seasons were all attributed to influenza but rather just "normal" deaths.

The excess all-cause deaths will be the figure to look at, but it will take quite a while before those numbers are reliable.

[gizmo]

But the excess death data will also be tainted because people, especially older people, avoid going to hospitals out of fear of catching covid19. Cancer screenings are way down, and fewer people go to the ER with heart attacks and the like. This will inevitably lead to excess mortality down the road --even among otherwise healthy people--, but it will be very hard to determine the magnitude of this second-order effect.

Of course it's also very hard to distinguish between people dying with covid19 and dying because of it. And we've never even made a serious effort to track the cause of death of the elderly.

Meaning we don't know how many people die each year from the flu, and we don't know how many people are dying of covid19. When you add it all up, it will be very difficult to learn the right lessons from this pandemic.

[DanBC]

That's not what excess mortality means. They don't say "this many extra people died, I guess it must be covid" -- they're not fucking idiots.

When cancer patients die because their cancer treatment was cancelled they die of a cancer related cause, and that's how their death will be recorded, and that's how their death will be reported.

> And we've never even made a serious effort to track the cause of death of the elderly.

It's hard to understand your "we" here. Which country doesn't try to track cause of death for elderly people?

> Meaning we don't know how many people die each year from the flu,

But we can count the deaths the same way. We can look at deaths of people confirmed to have the disease, we can look at death certificates, we can look at excess mortality combined with community surveillance. The errors for all three are going to be similar for flu and covid-19.

[gizmo]

> But we can count the deaths the same way.

When person in an elderly care facility dies we don't do a forensic investigation. We just shrug and say "I guess it was their time". So we don't have an accurate mortality baseline to do any comparison against. And that's assuming we are accurately distinguishing between those who died of covid19 and those who died with covid19, which we don't.

I'm not suggesting that people who draw conclusions from incomplete data are idiots, I'm pointing out that the data we have is completely insufficient to make an accurate assessment of covid19 mortality.

[alkonaut]

I think this is why excess all cause deaths will be the best evaluation. Lots of people who die from Covid in care homes are people who would have died from this years flu anyway. They aren't excess deaths, they are the baseline deaths.

[gizmo]

I agree that 'excess all cause deaths' is an important metric, but we still have to correct for clear biases in both directions. E.g. fewer traffic deaths because of a lockdown.

[DanBC]

> When person in an elderly care facility dies we don't do a forensic investigation. We just shrug and say "I guess it was their time".

This ("we just shrug and say "I guess it was their time"") is untrue. It's okay that you don't know, but you should stop spreading this misinformation.

[gizmo]

The first link I get when I google "accuracy of death certificates" is this one:

The accuracy of death certificates. Implications for health statistics. https://www.ncbi.nlm.nih.gov/pubmed/1871957

> Significant discrepancies between the two documents were observed in 50% of patients. In 25%, the immediate cause of death was incorrectly stated on the certificate, having been assigned to a different organ system in the majority of those cases. In 33%, there was disagreement on major disease other than the immediate cause of death.

Anecdotally, elderly people I've lost had completely wrong death certificates. When common sense, anecdotal evidence, and a cursory review of the scientific literature point in the same direction I'm going to assume that's the way it is.

Also, try to be kinder in the way you communicate.

[throwaway13337]

This is what's concerning all over the world.

We know that death rates with the disease vary a lot due to attribution.

We really can't get a good comparison as influenza isn't usually attributed as the main cause of death but coronavirus is.

We can only look at all cause mortality rates which is quite the lagging indicator.

https://www.euromomo.eu/graphs-and-maps/

The best we have.

[DanBC]

> as influenza isn't usually attributed as the main cause of death but coronavirus is.

What makes you say this?

[thu2111]

The UK made SARS-CoV-2 a "notifiable disease" which means by law any death from it must be reported to central government and it must be allocated to that death when present.

https://www.spectator.co.uk/article/The-evidence-on-Covid-19...

But there’s another, potentially even more serious problem: the way that deaths are recorded. If someone dies of a respiratory infection in the UK, the specific cause of the infection is not usually recorded, unless the illness is a rare ‘notifiable disease’. So the vast majority of respiratory deaths in the UK are recorded as bronchopneumonia, pneumonia, old age or a similar designation. We don’t really test for flu, or other seasonal infections. If the patient has, say, cancer, motor neurone disease or another serious disease, this will be recorded as the cause of death, even if the final illness was a respiratory infection. This means UK certifications normally under-record deaths due to respiratory infections.

Now look at what has happened since the emergence of Covid-19. The list of notifiable diseases has been updated. This list — as well as containing smallpox (which has been extinct for many years) and conditions such as anthrax, brucellosis, plague and rabies (which most UK doctors will never see in their entire careers) — has now been amended to include Covid-19. But not flu. That means every positive test for Covid-19 must be notified, in a way that it just would not be for flu or most other infections.

[DanBC]

The Spectator gets almost all of that wrong.

1) Death certificates rely on doctors using their best knowledge and experience to say what the patient died of, and what the patient died with. Flu and other respiratory illness is mentioned on many death certificates. See 5.4 here: https://assets.publishing.service.gov.uk/government/uploads/...

2) A notifiable illness has no meaning for death certificates.

3) We don't routinely test for flu. That's why all cause mortality is the preferred statistic for flu deaths, and also for covid-19 deaths.

[thu2111]

Huh. That's not the response I expected.

You're not arguing with the Spectator, they're just acting as a publisher. You're arguing with in his words, "a recently-retired Professor of Pathology and NHS consultant pathologist". So you're claiming a professional British pathologist doesn't understand how British death certificates work, and you know better. Bold move.

Especially so because you seem to actually be agreeing with what he wrote, which is weird. For instance your claim (3) exactly matches his claim that:

"the vast majority of respiratory deaths in the UK are recorded as bronchopneumonia, pneumonia, old age or a similar designation. We don’t really test for flu, or other seasonal infections."

You say flu appears on many death certificates. Yes and he never argued otherwise. He said despite that it's sometimes mentioned it's actually under-reported because testing isn't really done much for it - as you agreed with!

That leaves the question of notifiability. The rules say that COVID-19 must be mentioned on a death certificate if testing was done at all, even if negative (which is new to me, I wonder what that does to the widely cited stat of "number of certificates that mention COVID"). But the point is that relative to flu, testing deaths for COVID is enormous, practically blanket at this point. If you test a lot and you insist that every case is reported to central government it will cause a flood of reports to arrive on the desks of decision makers, who will then feel it's much worse than flu. But it's not, it's just a reporting artifact.